On January 1, 2008 I wrote the first blog entry on Science-Based Medicine introducing the new blog. Now, by coincidence, I have the privilege of writing the last entry of 2008. It seems like a good time to look back over the last year and reflect on our little project.

I am happy to write that by all measures SBM has been a satisfying success. Most blogs end after a few months. We not only kept up our schedule for the entire year, we expanding our writing about midway through the year. Given that there are millions of blogs, by necessity most blogs are relatively obscure. SBM rather quickly garnered a respectable readership and gained the attention of the some in the media as well as those with oppossing views.

I am very proud of the quality of the articles we have published here. Of course I have to thank all of my co-bloggers – David Gorski, Kim Atwood, Harriet Hall, Wally Sampson, and Mark Crislip who were with me from the beginning and Val Jones, David Kroll, Peter Lipson, and David Ramey who joined us part way through the year. Every week they each contributed a magazine-quality article, and then hung around to discuss their articles and others in the comments section. They all do this without any compensation, out of a pure desire to have a positive effect on the world.

At the request of a correspondent from the Quackwatch Healthfraud discussion list, I recently got embroiled in a debate with a couple of anti-vaccinationists in the pages of an Amish community newspaper, Plain Interests, published in Millersburg PA. They followed the usual pattern: they told the same old lies, they told partial truths distorted out of all recognition, and they omitted all those other truths that contradict their beliefs. Then they both challenged me to take all the recommended baby vaccines adjusted for weight to “demonstrate that vaccines are safe and effective.” If I refuse to do this, they say it will show that vaccinators are dishonest and that I’m afraid of my own medicine. They said I could win $150,000 by taking the challenge.

I did a little investigating. There is indeed a published challenge by Jock Doubleday, although the exact amount of money currently offered is unclear. His challenge reads:

The offer will continued to increase $5,000 per month, in perpetuity, until an M.D. or pharmaceutical company CEO, or any of the 14 relevant members of the ACIP (see below), agrees to drink a body-weight calibrated dose of the poisonous vaccine additives that M.D.s routinely inject into children in the name of health. The mixture will include, but will not be limited to, the following ingredients: thimerosal (a mercury derivative), ethylene glycol (antifreeze), phenol (a disinfectant dye), benzethonium chloride (a disinfectant), formaldehyde (a preservative and disinfectant), and aluminum.

However, more often, it’s none of these things. As much as they infuriate me, I believe that most reporters in the media do really want to get it right. However, they are hobbled by three things. First, many, if not most, of them have little training in science or the scientific method and are not particularly valued by their employers. For example, witness how CNN shut down their science division. Second, the only medical or science stories that seem to be valued are one of three types. The first type is the new breakthrough, the cool new discovery that might result in a new treatment or cure. Of course, this type doesn’t distinguish between science-based and non-science-based “breakthroughs.” They are both treated equally, which is why “alternative medicine” stories are so popular. The second type is the human interest story, which is inherently interesting to readers, listeners, or viewers because, well, it’s full of human interest. This sort of story involves the child fighting against long odds to get a needed transplant, for example, especially if the insurance company is refusing to pay for it. The third type, unfortunately, often coopts the second type and, to a lesser extent, the first type. I’m referring to the “medical controversy” story. Unfortunately, the “controversy” is usually more of a manufactroversy. In other words, it’s a fake controversy. No scientific controversy exists, but ideologues desperately try to make it appear as though a real scientific controversy exists. Non-medical examples include creationism versus evolution and the “9/11 Truth” movement versus history. Medical examples include the so-called “complementary and alternative medicine” movement versus science-based medicine and, of course, the anti-vaccine movement.

But the thing that most prevents the scientifically accurate evaluation by the media of unscientific health claims has to be the “tell both sides” culture of “balance” demanded by journalists. Telling both sides is, of course, very important when one side is not obviously correct compared to the other. Examples of such a situation include virtually any political controversy, where there almost always are two (and usually more) sides to an issue. In contrast, in science and medicine, there are not always two sides to an issue. (Again, think of creationism versus evolution.) In science and medicine, there is often a side supported so overwhelmingly by evidence, experimentation, and observation that the “other side” does not warrant being told, as it has already been considered and rejected by science. An excellent example of this is homeopathy. Another excellent example of this is the antivaccine movement, and, unfortunately, a prime example of “telling both sides” of the “vaccine debate” reared its ugly head a couple of weeks ago. Worse, it reared its ugly head on a show that ostensibly claims to be medically accurate, so much so that it features four doctors as its hosts.

I’m referring to a TV show called The Doctors. If the episode segment I’m about to discuss, which aired on December 11, is any indication, these are Doctors that anyone seeking scientifically sound information about medicine should run, not walk, away from.(more…)

A few years ago, at a skeptics conference in Los Angeles, Stephen Barrett of Quackwatch had just finished giving a talk and was fielding questions from the audience. Someone asked, “why don’t you ever talk about how dangerous regular medicine is?” Dr. Barrett, with a look of bewilderment in his face and a tone of exasperation in his voice, replied: “This is what I do.” That was his way of responding to a question that had nothing to do with his talk, as should have been obvious to both the questioner and the rest of the audience. The question might as well have been “why don’t you ever talk about global warming”?

If people are going to enter the fray of debate, at least they ought to play by the rules. One who doesn’t is the Intelligent Design apologist Michael Egnor, a nice counter-example to the popular myth that neurosurgeons are necessarily intelligent. I’m aware that Steve Novella posted the day before yesterday in response to Egnor’s recent lament about our close friend Orac and about Dr. Novella himself. I couldn’t help but stick in my two cents, however, because deconstructing Egnor’s essay is like shooting fish in a barrel, and it seemed appropriate for Boxing Day. I have avoided reading Dr. Novella’s piece so as not to color my own thinking, so please forgive any redundancies (speaking of that, I’m not the first to make the obvious pun of Egnor’s name). My post will be short and sweet and sour.

Science-based medicine is more than a website. It is a philosophy of medicine that is actively vying with other philosophies for dominance in the world of medicine. We believe that medicine should be based upon the best science available, according to a single universal standard of rigorous methodology and valid logic and reason. Others desire a double-standard, so that they can be free to practice or market whatever they wish without having to meet strict scientific standards. Still others have a non-scientific ideological world-view and want public policy to accord to, or at least admit, their personal beliefs.

I therefore expect that we will be attacked by proponents of unscientific medicine in all its forms. Yesterday, however, we were attacked on the Evolution News & Views website of the Discovery Institute by creationist neurosurgeon, Michael Egnor. This may seem incongruous at first, but honestly I suspected that just such an attack was inevitable.

Many science bloggers, David Gorski and me prominent among them, have taken on both the DI and Dr. Egnor specifically over many anti-scientific arguments he has put forward over the last couple of years. We have sparred mostly about evolution in medicine, neuroscience and consciousness, and the materialist underpinnings of modern science. Dr Egnor’s day job, however, is that of a (from what I can tell) respected neurosurgeon, so I always wondered what he thought of his sparring partners’ writings about science-based medicine.

His entry yesterday ends any speculation – he wrote an incoherent, logical fallacy-ridden screed that would make any snake-oil peddler proud. This reinforces a point I have made in other contexts – all anti-scientific philosophies have science as a common enemy, and will tend to band together in an “unholy alliance” against those advocating for scientific rigor or defending science from ideological attack. That is why a website that is ostensibly about the “misreporting of the evolution issue” would post a blog attacking science-based medicine as an “arrogant medical priesthood.”

Since Val has broken the ice, I thought I would offer some more Christmas humor. The following is a Narrative Summary (a report of a hospitalization) that was circulated at the Plattsburgh Air Force hospital where I worked in 1986. I published it in my memoirs, Women Aren’t Supposed to Fly. Unfortunately I don’t know who wrote it, so I can’t give credit where credit is due.

CHIEF COMPLAINT: Frostbitten tallywhacker.
HISTORY OF THE PRESENT ILLNESS: The patient is a three hundred and eight year old supernatural being employed as a stealth sleigh driver, powered by reindeer, who comes in on Christmas Eve stating that he was coming over the northern part of the Yukon Territory and, unfortunately, the fly of his pants came open, and his member was exposed to some rather cold air flowing by at rather high velocity. Unfortunately, he did not notice right at first and attempted to slide down a chimney at which point, he then scraped his member on the edge of the bricks. He now comes in appearing quite uncomfortable, and complaining of pain in his genital area. He also noted some mild abdominal discomfort, and admits to drinking large amounts of ethylene glycol earlier this evening, prior to his trip. The patient is rather vague about his trip but indicates that he really needs to be on his way, and really just wants something for his pain.
PAST AND FAMILY HISTORY: The patient gives a remarkable lack of much past history despite his age. He notes that about this time every year he does get rather anxious and occasionally requires some sedatives to calm him down. He also has occasional bouts with hemorrhoids, and was recently seen at this hospital for the same complaint while on a supply run. Family history is rather unremarkable, in fact, he doesn’t recall that he has any family other than his wife, twenty-two elves, and eight reindeer – one who seems to be constantly bothered by a red and runny nose. He is employed as a sleigh driver for the Arctic Air Force, but fails to reveal much other detail, saying he is on a “Super-Duper Top Clearance Mission.” He does claim to have recently recharged his batteries. Apparently, by that he means he had a nuclear-powered penile implant because he said even at 308 years old he still does enjoy his sexual activity, and that he just wasn’t quite as potent as he used to be.
PHYSICAL EXAMINATION: The patient has a blood pressure of 168/90. Pulse is 72, and regular. Respiratory rate is 18. He is afebrile. The patient is a rather old, jolly fellow. He is dressed in fur from his head to his foot and his clothes are all tarnished with ashes and soot. His eyes have a twinkle, his dimples how merry. His cheeks are like roses, his nose like a cherry. The stump of a pipe he clenches in his teeth, and the smoke encircles his head like a wreath. He is rather short, and has a little round belly that shakes when he laughs like a bowl full of jelly. The rest of the examination is remarkable for a rather large member. It appears to have some external abrasions, and some very mild frostbite at the tip. An eerie glow seems to emanate from his left femoral region, this is apparently his nuclear-powered implant.
LABORATORY DATA: Is remarkable for an ethylene glycol level of 38.
DIAGNOSIS: 1. Frostbitten penis secondary to exposure with some external abrasions.
2. Ethylene glycol intoxication.
3. Obesity, and mild gastritis secondary to number 2 and to excessive intake of snacks tonight.
COURSE IN THE HOSPITAL: The patient was admitted to the Internal Medicine Service. Surgical consultation with Dr. Costanzo was obtained, who debrided some frostbitten area. Right after this, the patient became quite agitated and signed out against medical advice (AMA) stating that he had a trip which he must complete tonight.
DISPOSITION: The patient was advised to keep his member covered for the remainder of the trip, and that we will look forward to seeing him again next year.

I’m having a helluva Sunday. My father-in-law’s in the hospital, it’s 2 degrees out with a wind chill of 40 below, my clothes all smell like latkes, my daughter is having a melt-down, and I screwed up the .xml file for my podcast. The last part reminds me of something—science is hard, and when we step out of our areas of expertise, it’s easy to make some pretty silly mistakes.

If you don’t understand the basics of a subject, it’s easy to form conclusions that seem logical, but these same conclusions seem silly to those who have a deeper understanding of a subject.

With may damned podcast, I’m writing xml files based on templates—little thinking is involved. I’m looking at other people’s code and inserting my own details, hoping it works. If I actually understood the syntax of xml files, I could write a correct one based on a solid understanding of the specifics of the subject.

Medicine is one of those areas in which we all feel we should be experts. After all, we all have a body, and we figure that our bodies follow a logic that we can plainly see—if you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die? It all seems so logical.

Colons are full of poop. Poop is yucky. Therefore, cleaning out a colon is good.

Except that it’s not true. The human body is rather complex, and the study of the aggregate of all human bodies living together (e.g. public health) is more complex still.

Since the world of cult medicine hasn’t bothered to learn real science, they often rest on what sounds “right”. Like poop being yucky, this is often based on a sliver of fact that is horribly misused due to ignorance.

One of the more popular canards propagated by cult medicine leaders and their followers is that modern medical care kills. Rather than exploring what the data are and what they mean in order to find a problem and correct it, they manufacture a problem out of whole cloth and come up with non sequitor solutions.

I’m referring to so-called “battlefield acupuncture,” a topic that I wrote about last week for this very blog. With a week separating my usual posts, I normally don’t write about the same topic two times right in a row, but I’m making an exception for this topic. There are three reasons. First, I remain appalled at how one ideologue, Col. (Dr.) Richard Niemtzow, a radiation oncologist and Air Force physician turned number one advocate of acupuncture use in the military, has succeeded in introducing acupuncture into not only military hospitals like Walter Reed Army Medical Center and Landstuhl Regional Medical Center (which is, by the way, the first stop outside of the Middle East for our wounded soldiers from Iraq and Afghanistan), but has even started to train U.S. Army Rangers in the technique. While before I thought the term “battlefield acupuncture” was a misnomer because it wasn’t actually being used on the battlefield, but rather for phantom limb pain and other chronic pain conditions, this latter development shows just how far Col. Niemtzow wishes to go with this “technique.” Second, Col. Niemtzow’s acupuncture technique isn’t even “real” acupuncture. He calls it “auricular acupuncture,” and it involves sticking needles a mere 1 mm into the earlobe. Worse, he justifies this technique through ignorance of anatomy, claiming that “the ear acts as a ‘monitor’ of signals passing from body sensors to the brain” and that “those signals can be intercepted and manipulated to stop pain or for other purposes.” He even made a comment about 18th century pirates wearing a lot of earrings in order to improve their night vision. I kid you not. Third, and finally, Col. Niemtzow has published another one of his “studies” to support the use of acupuncture in chronic pain syndromes among our combat wounded veterans.

Last time around, I referred to an earlier study by Col. Niemtzow published in Military Medicine in 2006. This study was clearly labeled as a “pilot study.” Although it was randomized (good), it was small (tolerable for a pilot study); it was unblinded (bad); and there was no placebo or “sham acupuncture” control group (horrible). There were multiple other serious shortcomings, but those are the main ones. In other words, Col. Niemtzow’s 2006 study was custom-designed to show a “positive” result that could be entirely explained by the placebo effect, and that’s exactly what it did. Indeed, even by that standard, its results were unimpressive. Although the pain scores in the acupuncture group were reported to have decreased by 23% initially, compared to the conventional therapy group, which did not decrease measurably, within 24 hours after treatment there was no difference between the two groups. I’ve referred to this study as “thin gruel” upon which to base the creation of a military acupuncture program, much less expanding that program into combat and training military physicians and medics being sent to combat zones in Iraq and Afghanistan to do auricular acupuncture. I still say it’s thin gruel,.

So what about this new study by Col. Niemtzow, hot off the presses in the latest issue of Medical Acupuncture?(more…)

“There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”- Donald Rumsfeld

How do we know what we know? It is said by some anti-vaccine proponents that vaccines are not needed because the diseases they prevent are either gone or no longer as severe as they were in pre vaccine times. People may have suffered and died in the distant past, but no longer. The risk now is from the vaccines not the diseases they no longer prevent.

36,000 people, more or less, die every year from influenza. That is the number of deaths according to the CDC web site; the NEJM review uses the higher number of 56,000 (7). Which number is correct? Isn’t that why the flu vaccine is recommended: to prevent all those people from dying.

36,000 is a lot of people. That’s about 120 deaths per million people in the US. In Oregon, population about 3 million, that would be about 360 people a year, which is two deaths a day for the six month flu season.

“Death is caused by swallowing small amounts of saliva over a long period of time.”–George Carlin.

2,400,000 people die every year in the US, about 6600 a day. In Oregon, that is about 65 deaths a day. No one outside a epidemiologist is going to notice 2 extra deaths a day during flu season. I have seen a lot of people die of influenza, but I have a biased experience: I am an infectious disease doc, so I am likely to see people with influenza, especially patients with disease severe enough to kill them.

About the same number of people die from car accidents and die from handguns in the US each year as die from influenza. I have never known a person in my real, as opposed to my professional, life to die from influenza or handguns or a car accident. My personal experience suggests no one dies from these causes, but since I take care of patients at one of the Portland trauma hospitals, I know what cars and guns do to people. My professional life confirms that people do indeed die from being shot or car accidents. I would wager that most people reading this blog have not known anyone who has died from influenza, guns or car accidents. The fact that people do die of influenza seems contradicted by experience. Why get the vaccine? I don’t get the flu and and no one I know has ever died from it.

As an illustrative example, a relative of mine, a retired physician, mentioned that he thought the shingles vaccine was a waste of time and money as he had never known anyone to get shingles. Using personal experience to judge disease prevalence is unreliable. If I applied the same rationale to driving, I would not wear a seat belt as I have never been in a high speed crash.

36,000 people die of influenza each year. What is the source of that statistic? From “Mortality associated with influenza and respiratory syncytial virus in the United States”. JAMA 2003. Is that really how many deaths are there from influenza? It depends on what you mean by ‘death’ and what you mean by ‘influenza’ and what you mean by ‘from’.

Academic politeness turns to the vicious This is more on the theme of academic and postmodern roots of sectarianism-quackery’s advance on medicine. I illustrate through the personal experience of a noted combatant – Mary Lefkowitz – in the front lines of the war with intellectual and academic buffoonery passing as scholarship. The joke is not in the buffoonery, though. The joke is turning on us.

Some of you are familiar with Prof.Lefkowitz’s academic dispute from publicity last spring. Prof. Lefkowitz is on the list of academic opponents to relativism and postmodernism. Lefkowitz’s travail began in 1993 when another Wellesley faculty member who led a department or course of Africana Studies claimed in lectures that ancient Greek and Roman intellectual advances were lifted from libraries and other sources of ancient Egypt, and that furthermore, those Egyptians were black Africans.

You recognize this as Afrocentrism, one of relativism and postmodernism’s multi-pronged attack on intellectualism and Western civilization. I attended a session on the problem in 1992 (or so) at the AAAS in San Francisco, and did not appreciate or understand what was going on, or why the raised rhetoric and voices. I do now, especially having read excerpts from Lefkowitz’s book, History Lesson, published earlier this year.(more…)